California Institute for Nursing

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California Institute for Nursing Healthcare

• Betty Irene Moore Nursing Initiative Nursing
  Education Redesign for California

Jan Boller, RN, PhD Deloras Jones, RN,
MSN Project Director Executive Director
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California Institute for Nursing Health Care

• A multi-stakeholder, nonprofit organization
  committed to serving as a catalyst for action as
  we address nursing and related healthcare issues
  to improve the health of Californians through
  strategic workforce planning, research,
  education, and policy recommendations.
• Optimizing the Health of Californians through
• Nursing Excellence

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The Demand Nursing Excellence

• Patient/client-centered, (not task-centered)
  Patient advocates who provide safe passage
• Critical thinkers, clinical judgment, systems
  thinkers
• Use evidence-based practice
• Community-based, Population-based, Prevention
  Health-Promotion-based
• Technology-proficient
• High-level patient teaching skills healthy
  lifestyle practices
• Innovators in complex, chaotic care systems
• Lead interdisciplinary teams in coordinated care
  throughout the continuum

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The Supply Sobering Statistics

• Nursing shortage
• Gaps in education of new graduates
• Retention of new graduates
• Educational advancement

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Nurse ShortageCalifornia Nursing Workforce

• 223,000 RNs working in California
• Average age 47.7 years
• California ranks next to last in RNs per capita
• 544 California, 782 national average

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Nurse Shortage Demand for Nurses

• Hospitals reporting 11 to 15 vacancy rates
• 14,000 RN vacancies
• California EDD projected need for nearly 110,000
  new nurses between 2000 and 2010
• Capacity to educate ½ that number
• HRSA forecasts by 2010 demand will be 47,600 more
  than supply24 short fall
• HRSA forecasts by 2020 demand will be 116,000
  more than supply45 short fall

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Nurse Shortage Educational Pipeline

• California schools have capacity to educate only
  ½ of nurses needed
• Schools have increased capacity 10 within last 5
  years, yet capacity is just over what it was in
  1994-95
• Most of increase has been through hospitals
  contributions to education
• Attrition rates between 20 to 26
• Only 40 of qualified applicants are admitted

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NCSBN Elements Study Gaps in Nursing
Education (reported by students)

• Administer medicine to groups of patients
• Delegate tasks to others
• Supervise care by others
• Knowing when and how to call the physician (also
  in Carnegie Study)

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Gaps in Nursing Education from NCSBN Elements
Study (reported by faculty)

• Content not being taught consistently
• Use of information technology (8.4 of programs)
• Evidence-based practice 11.7 of programs
• Critical care 9.1 of programs
• Interdisciplinary elements 32.5 of programs
• Only 55.9 of programs allow students to call MDs

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Key Theme Demands Immediate Attention

• Nurses are still eating their young
• Lateral violence
• Unhealthy workplaces
• Educational strategies for inoculation?

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Transition Study Practice Errors New Nurses

• Charted on wrong record 55.2
• Medication errors 43.2
• Contribute to treatment delays 39.3
• Missed physician/provider order 38.5
• Client falls 34.9
• Error in performance of skills 28.2
• Misinterpreted physician order 23.8
• Client elopement 13.3
• Avoidable client death 1.1

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New Nurses Make Significantly Fewer Errors When

• More competent in clinical reasoning
• More competent in communication and interpersonal
  relationships

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Retention of New Graduates in California
Educational Advancement

• lt65 retention at the end of the second year of
  employment
• 70 of new graduates in California are AD
  prepared. Important entry point for RNs. However,
  only 17 advance to BSN or beyond with increasing
  demand for BSN and graduate level credentials

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What is CINHC Doing to Address this Problem?

• Master Plan Education, Workplace, Diversity
• Funding, Policy, Collaboration
• Strategies for Increasing Educational Capacity
• Regional Shared Services
• Computerized Clinical Placement System
• Faculty Resource Center
• Regional Clinical Simulation Centers
• Faculty Development
• Magic in Teaching Compendium 2005, November
  1, 2007
• Clinical Faculty Training Program for Clinical
  Nurses
• Leadership Development Building a Foundation for
  Leadership Excellence, in partnership with ACNL

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Grant Overview

• A Nursing Education Redesign in California
  White Paper and Strategic Action Priorities that
  examines the need to reshape nursing education,
  makes recommendation on redesign elements,
  defines the action steps, and provides plans for
  building consensus required to accomplish
  redesign.

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Program/Project Profile

• Why was this program selected?
• a. Concerns about student readiness for entry
  into practice in todays complex health
  environment. Concerns about patient safety and
  quality of care
• b. Faculty concerns about maintaining
  quality education with increased enrollments
• Driving forces affecting quality of education
• a. Nursing and faculty shortage
• b. Changes in health care environment
• c. Availability of simulation and other
  innovations in education
• d. Renewed interest in collaboration
  between academia and service

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Nursing Education Redesign for California Plan

• Gather Data About Advances in Education Key
  Challenges to Delivering Quality Education
• Convene Thought Leaders
• Identify Core Competencies/Gaps
• Outline Key Action Strategies
• Meet with Key Stakeholders For Feedback and to
  Build Consensus Across the State
• Publish and Dissemination Action Plan (White
  Paper)

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Project Approach

• Build relationships through conversation,
  dialogue, and consensus-building
• Appreciative inquiry
• Cultivate communities of practice among
  clinicians, educators, policy makers
• Participatory action science approach, focusing
  on reflection and action
• Quality improvement processes, using small tests
  of change.

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Preliminary DataBased on 1st Thought Leader
Survey

• Gaps in core competencies
• (Based on Competencies Identified by Oregon
  Consortium for Nursing Education)
• Makes sound clinical judgment
• Collaborates as part of a health care team
• Practices within, utilizes and contributes to the
  broader health care system
• Uses best available evidence in making practice
  decision

• IOM Quality Safety Competencies
• Patient-centered care
• Interdisciplinary team
• Evidence-based practice
• Quality improvement approaches
• Informatics

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Preliminary Recommendations

• Strategic Action Priorities
• Core competencies needed for 21st century
  professional clinical
• Transition to practice Formal residencies/interns
  hips
• Forging academic/service partnerships Common
  unified voice for nursing excellence, clinical
  rotations, preceptorships, healthy workplace
• Collaborative education model Seamless and
  timely advancement from ADN to BSN to Graduate
• Integrate simulation, other innovations and
  evidence/based, best practices into curriculum
• Faculty development to learn new ways to teach
• Explore evaluate new and innovative out of the
  box programs to respond to the nursing shortage
• Economic models for funding education

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We must bridge the chasm between academia and
service when it comes to preparing nurses.

• Smooth transitions
• Role socialization
• Community of practice
• Theory cannot be separated from practice
• Nursing is a practice-based profession

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Call to Action Lets Get Together

• Stop lateral violence NOW (nurses eating their
  young)
• Solve clinical rotation problems
• Develop high-performing faculty (academic
  clinical)
• Build collaborative curriculum from
  novice-to-expert

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Contact Information

• California Institute for Nursing Health Care
• 1815 B Fourth Street
• Berkeley, CA 94710
• [phone]
• jan_at_cinhc.org
• deloras_at_cinhc.org
• www.cinhc.org